Category: Health & Medicine

The Coronavirus Outbreak: How Democratic Taiwan Outperformed Authoritarian China.
Taiwan’s example proves that the free flow of information is the best treatment for the coronavirus outbreak.

The novel strain of coronavirus (officially dubbed COVID-19) that originated in Wuhan, China has spread to almost 30 countries, including regional neighbors like South Korea, Japan, and Taiwan, and countries as far away as the United States, Canada, and Brazil. As of February 26, more than 81,000 cases have been confirmed worldwide, and the death toll has surpassed 2,700, mostly in China. The epicenter of the virus crisis, China, has been suffering socially and economically not only on account of the virus, but also because of the Chinese government’s problematic policies.

The Chinese government has been working to tackle the coronavirus outbreak by using multiple measures to contain the spread of the virus as well as information about the outbreak. Most famously, the government imposed an extreme quarantine in Wuhan on January 23, which is still in place over a month later. Many cities in Hubei province and elsewhere in China have also implemented lockdowns or restrictions while cases of infection continue to increase.

Besides these measures in the physical world, the Chinese government has attempted to quarantine discussion of the epidemic in the realm of public opinion. From the first appearance of the new virus last December to the lockdown of massive cities in mid-January, the Chinese authorities chose to restrict public access to the information about the epidemic by silencing people, most famously the whistleblower Doctor Li Wenliang. In the early stages of the outbreak, the Chinese government issued a statement asserting that “the disease is preventable and controllable,” and announcements sent by Chinese officials to World Health Organization (WHO) office in Beijing claimed that there was no evidence of the disease being transmitted between humans.

But the Chinese scientists writing in The Lancet medical journal later revealed that the first patient known to have contracted the novel coronavirus had no link to the Wuhan seafood market that the Chinese government pointed to as the source of the outbreak. This would suggest that the virus all along was spreading via human-to-human transmission – and that the government was lying to the public from the very beginning of this catastrophe.

Chinese news outlet Caixin covered the story of Dr. Li Wenliang, who became famous after being detained for posting about the new virus online. Li later died of the coronavirus himself, inspiring rare public anger against China’s censorship system. “There should be more than one voice in a healthy society,” Li told Caixin. When his death was reported, Chinese social media platforms were flooded with netizens’ anger and calls for freedom of speech. It seemed for a moment that the Chinese media and civil society had won more space for free speech, granted by the Chinese government as a safety valve for the pressure building from the bottom up.

But in fact, the central government began tightening its media and online controls soon, after a short period of tolerance. In February 2020, two Chinese citizen journalists disappeared after continuously reporting stories about the outbreak and posted them online. The Chinese government then expelled three Wall Street Journal reporters, taking advantage of accusations of racism over an editorial headline. In the meantime, China’s top cyber regulator required online technology companies to “create a good online atmosphere” for fighting the virus, and many social media apps and accounts were removed because of their posts of so-called harmful content. The Chinese propaganda department guided the domestic media to cover only positive stories on the coronavirus crisis relief work being done by Chinese authorities. The central government even dispatched journalists to the center of outbreak to accomplish this mission.

Whether China is stepping up propaganda or strengthening media and cyber controls, its primary goal is to maintain regime stability and social control, not to contain the virus outbreak.

On the contrary, Taiwan, a country that has been excluded from the WHO for decades thanks to China’s political pressure, has demonstrated that the better way to contain the coronavirus is not to quarantine news about epidemic, but to make it easier and more convenient for people to access relevant information………..

Coronavirus infects woman in Japan for the second time, a first in the country

Okay, this is either 1, when the woman was tested clear, it was a ‘false negative’, or 2, she was reinfected by someone, or 3, the bug has ‘crypto’ capability, the ability to hide within the body, then spring forth anew.

A woman in Japan tested positive for the coronavirus for the second time on Wednesday, as the country grips with 190 cases separate from the Diamond Princess cruise ship outbreak, according to multiple reports.

The tour bus guide in her 40s first tested positive in late January and was released from the hospital after recovering. She was readmitted after having a sore throat and chest pains, according to the local government.

It’s a first known case of a second positive test in Japan, which prompted Health Minister Katsunobu Kato to inform Japan’s central government of the need to review previous patient lists and monitor the condition of those previously discharged, according to Reuters.

“Once you have the infection, it could remain dormant and with minimal symptoms, and then you can get an exacerbation if it finds its way into the lungs,” said Philip Tierno Jr., professor of microbiology and pathology at NYU School of Medicine, according to the news organization.

The virus can reportedly spread without symptoms showing up, which forces officials to play catch up and makes it far more difficult to manage.

Health officials analyzed the implications of a patient testing positive after having an initial recovery. Second positive tests have been reported in China.

“I’m not certain that this is not bi-phasic, like anthrax,” Tierno Jr. said in regards to the disease being able to go away before reappearing.

Trump Says Coronavirus Vaccine Coming Along ‘Rapidly, ‘ Appoints Pence to Head Task Force

As fears spread of a possible coronavirus outbreak in the U.S, President Trump addressed the nation in a Wednesday evening news conference at the White House to discuss how his administration was handling the virus threat — saying that a vaccine is being developed “rapidly” and “coming along very well.”

However, Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, said later at the press conference that a vaccine would not be applicable to the epidemic for a “year to a year and a half,” due to delays from testing, development, production and distribution.

Northern California Confirms 1st Coronavirus Case of Unknown Origin

The nation’s first coronavirus case of unknown origin has been confirmed in Northern California, the Centers for Disease Control and Prevention (CDC) confirmed Wednesday.

“It is a confirmed case. There is one in Northern California,” CDC spokesman Scott Pauley told the Sacramento Bee.

The new case brings the number of infected in the United States to 60, which includes people who’ve been repatriated to the U.S. The CDC said the person contracted the virus without traveling outside the U.S. or coming into close contact with another infected patient, The Washington Post reported.

Transcript for the CDC Telebriefing Update on COVID-19

Audio recording media icon[MP3 – 6 MB]

Please Note: This transcript is not edited and may contain errors.

Welcome and thank you for standing by.  At this time, all participants are on listen-only mode until our question and answer session.  At that time, if you would like to ask a question, please press star then one.  Please be advised today’s conference is being recorded.  If you have any objections, you may disconnect at this time.  Now I would like to turn the meeting over to Mr. Benjamin Haynes.  Thank you.  You may begin.

Thank you.  And thank you all for joining us for today’s update on CDC’s COVID-19 response.  We are joined by the director of CDC’s national center for immunization and respiratory diseases who will give opening remarks.  I will now turn the call over.

Thank you for joining us.  The global novel coronavirus situation is rapidly evolving and expanding.  There are still a lot of news coverage about community spread in a few countries since the last time we talked.

This means that cases of COVID-19 are appearing without a known source of exposure.  Communities include Hong Kong, Italy, Iran, Singapore, South Korea, Taiwan, and Thailand.  Community spread is often a trigger to begin implementing new strategies tailored to local circumstances that blunt the impact of disease and can slow the spread of virus.

The fact this virus has caused illness – including illness resulting in death, and sustained person-to-person spread is concerning.  These factors meet two of the criteria of the pandemic.  The world moves closer towards meeting the third criteria.  Worldwide spread of the new virus.

The U.S. has been implementing an aggressive containment strategy that requires detecting, tracking, and isolating all cases.  As much as possible and preventing more introduction of disease notably at points of entry.  We’ve restricted travel into the United States while also issuing extensive travel advisories for countries currently experiencing community spread.  Our travel notices are changing almost daily.

We’ve also enacted the first quarantine of this scale in the U.S. And are supporting the state department and HHS in repatriating citizens from high-risk areas.  We are doing this with the goal of slowing the introduction of this new virus into the U.S. And buying us more time to prepare.  To date, our containment strategies have been largely successful.  As a result, we have very few cases in the United States and no spread in the community.  But as more and more countries experience community spread, successful containment at our borders becomes harder and harder.

Ultimately, we expect we will see community spread in this country.  It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness.  We will maintain for as long as practical a dual approach where we continue measures to contain this disease but also employ strategies to minimize the impact on our communities.

At this time, there’s no vaccine to protect against this new virus and no medications approved to treat it.  Non-pharmaceutical interventions or NPIs will be the most important tools in our response to this virus.  What these interventions look like at the community level will vary depending on local conditions.  What is appropriate for one community seeing local transmission won’t necessarily be appropriate for a community where no local transmission has occurred.  This parallel, proactive approach of containment and mitigation will delay the emergence of community spread in the United States while simultaneously reducing its ultimate impact.

To illustrate how this works, I’d like to share with you some of the specific recommendations made in the document I mentioned last Friday including some of the steps we would take here if needed.  This document is called Community Mitigation Guidelines to Prevent Pandemic Influenza United States 2017.  It draws from the findings of nearly 200 journal articles written between 1990 and 2016.

This document looked at what can be done at the individual and community level during a pandemic when we don’t have a vaccine or proven medical treatment for the disease.  We’re looking at data since 2016 and adjusting our recommendations to the specific circumstances of COVID-19.  But this posted document provides a frame work for our response strategy.  Based on what is known now, we would implement these NPI measures in a very aggressive, proactive way as he have been doing with our containment efforts.

There are three categories of NPIs.  Personal NPIs which include personal protective measures you can take every day and personal protective measures reserved for pandemics.  Community NPIs which include social distancing measures designed to keep people who are sick away from others.  And school closures and dismissals.  And environmental NPIs which includes surface cleaning measures.  NPIs routinely recommended for prevention of respiratory virus transmission include everyday personal protective measures.

These are preventive measures we recommend during influenza season.  These NPIs are recommended during a pandemic regardless of the severity level of the respiratory illness.  Personal protective measures reserved for pandemics include voluntary home quarantine of household members who have been exposed to someone they live with who is sick.  Now I’d like to talk through some examples of what community NPIs look like.

These are practical measures that can help limit exposure by reducing exposure in community settings.  Students in smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education.  For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options.

On a larger scale, communities may need to modify, postpone, or cancel mass gatherings.  Looking at how to increase telehealth services and delaying elective surgery.  The implementation of environmental NPIs would require everyone to consistently clean frequently touched surfaces and objects at home, at school, at work, and at large gatherings.

Local communities will need to look at which NPIs to implement and when based on how transmission and disease is and what can be done locally.  This will require flexibility and adaptations as disease progresses and new information becomes available.  Some of these measures are better than none.  But the maximum benefit occurs when the elements are layered upon each other.

Some community level interventions that may be most effective in reducing the spread of a new virus like school closures are also the most likely to be associated with unwanted consequences and further disruptions.  Secondary consequences of some of these measures might include missed work and loss of income.  I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe.  But these are things that people need to start thinking about now.

I had a conversation with my family over breakfast this morning and I told my children that while I didn’t think that they were at risk right now, we as a family need to be preparing for significant disruption of our lives.  You should ask your children’s school about their plans for school dismissals or school closures.

If ask if there are plans for teleschool.  I contacted my local school superintendent this morning with exactly those questions.  You should think about what you would do for childcare if schools or day cares close.  If teleworking is an option for you.  All of these questions can help you be better prepared for what might happen.

CDC and other federal agencies have been practicing for this since the 2019 influenza pandemic.  In the last two years, CDC has engaged in two pandemic influenza exercises that have required us to prepare for a severe pandemic and just this past year we had a whole of government exercise practicing similarly around a pandemic of influenza.

Right now CDC is operationalizing all of its pandemic response plans working on multiple fronts including specific measures to prepare communities to respond to local transmission of the virus that causes COVID-19.  Before I take questions, I want to address the issue of the test kits CDC is developing.

I am frustrated like I know many of you are that we have had issues with our test.  I want to assure you that we are working to modify the kit and hope to send out a new version to state and local jurisdictions soon.  There are currently 12 states or localities around the U.S. That can test samples as well as we are testing at CDC 400 samples were tested overnight.

There is no current backlog or delay for testing at CDC.  Commercial labs will also be coming online soon with their own tests.  This will allow the greatest number of tests to happen closer to where potential cases are.  Last, I want to recognize that people are concerned about this situation.  I would say rightfully so.  I’m concerned about the situation.  CDC is concerned about the situation.  But we are putting our concerns to work preparing.

And now is the time for businesses, hospitals, community schools, and everyday people to begin preparing as well.  Over the last few weeks, CDC has been on dozens of calls with different partners in the health, retail, education, and business sectors.  In the hopes that employers begin to respond in a flexible way to differing levels of severity, to refine their business response plans as needed.  I also want to acknowledge the importance of uncertainty.  During an outbreak with a new virus, there is a lot of uncertainty.  Our guidance and advice are likely to be fluid subject to change as we learn more.  We will continue to keep you updated.  I’d be happy to take a few questions now.

Brittany, we’re ready to take questions.

Thank you.  We’ll now begin our question and answer session.  If you would like to ask a question over the phone, press star, then one and record your name clearly when prompted.  If you need to withdraw your question, press star then two.  One moment as we wait for the first question.  Our first question comes from Lisa from PBS.  Your line is now open.

Good morning.  Thank you for doing this.  I have some more questions about the test kits.  Thank you for what you gave us the update on, but can you go into more detail about how they work?  Can any hospital now just kind of use a swab to get a sample and then send that to the CDC?  And then how long do you estimate it will take to have the kits replaced so that more localities can actually do the analysis and do you have enough money for this kind of field work and test analysis right now?

Okay.  I’m going to start from maybe the part of a patient perspective which is, you know, right now our focus is still on individuals with a travel history that would put them at risk for COVID-19.  Or people who are close contacts of someone who has COVID-19.  Those individuals when they are identified by a health care provider, the health care provider calls the health department.

The health department helps them triage those patients to make — and then the samples are worked with the health department.  Now, as we move forward, though, if we are looking at the trajectory of expecting that there likely will be community spread of this virus in the united states, the case definition may change away from narrowly around people with travel.

Again, that’s what we would anticipate doing as there is community spread.  If that happens, it will be more and more important that the clinicians have a full tool kit.  That’s why the availability of commercial kits would be so helpful.  So in the short-term, it’s the clinician calls the health department.  And either the health department already has the test kit themselves or if they don’t yet have it stood up, they send it to CDC.  Our turnaround at CDC is within a day.

There is a little bit of shipping time.  But that’s the process.  In terms of timing, I think at this point what I would say is we are working as fast as we can.  We understand the frustration of our partners in the health care sector, in health departments.  You certainly can imagine we want to resolve this as quickly as possible.  But we have to make sure that while resolving it, we keep to the highest level of quality assurance.  Because as important as speed is, it is more important that we make sure that our results are correct.

In terms of funding, there’s already been funds available that are helping us with the activities that we have now that is the diagnostic testing at CDC.  And we’ll continue to proceed focused on our priorities which as I’ve said are getting this test kit out to state health departments so they can be doing that themselves as an interim step to getting it commercially available would be a great advancement.  Next question.

Thank you.  And our next question comes from Craig from KNX 1070 news radio Los Angeles.  Your line is now open.

Thank you, doctor.  I appreciate your time.  Couple of questions.  There’s been a lot of talk about what’s being done to prepare for possible people who would be quarantined.  I’d like to know what that is.  And also is the Chinese government leveling with you?  Are they telling you the truth?  Have they given you the straight dope, so to speak, as to what you need to know about the coronavirus?

So in answer to your first question, I would say generally we are working on a daily basis with state and local health departments across the country on exactly those issues.  What are the local considerations for quarantine or isolation and how can they be resolved?  And in each location in the united states, it may end up being a slightly different answer.

Our focus is on the best health of the individual whom we are working with in terms of whether they need quarantine or isolation.  In terms of the Chinese government, there has been a WHO team on the ground in China as well in Wuhan.  There are data coming out from those efforts.  We have a lot of information from china.

Frankly, we have a lot of new information from all the other countries around the world now that are reporting community spread and we are as quickly as possible trying to synthesize that information.  It is providing us more data in terms of making our own estimations in the U.S. Of what we’re going to see.  Communities that are having community spread are certainly very informative in terms of what we might expect in the united states.

And I think that whole body of evidence is frankly coming really quickly at us.  That’s why we have a team of people here at CDC synthesizing it all.

Next question, please.

Thank you.  And our next question comes from Megan from STAT.  Your line is now open.

Hi there.  Thank you so much for taking my question.  I’m wondering if you could expand a little bit on whether you are reconsidering testing people with travel history to other countries now where they might be infected.  And I’m also wondering if you could say whether or not the agency has considered getting tests from another country that’s supplying tests to other nations as well.

So the answer to the first question is certainly, we’re considering what the spread of illness in other countries looks like and how it impacts the potential risk the Americans traveling abroad in those countries.  Those conversations are going on as we speak.  We obviously are working closely with the partners on those considerations.  And when there is new information in terms of case definitions, we’ll definitely publicize that broadly.

You know, as I said, we are still at the stage of containment, but we are already starting to plan for mitigation.  And part of the mitigation planning is the participation of community spread in the united states.  And as that happens, it would certainly dramatically impact how we’re considering who is on the case.  As you can imagine, the symptoms of novel coronavirus look a lot like other viral respiratory diseases that are circulating this time of year.

So it’s going to be difficult for clinicians to differentiate fully on the basis of those — solely on the basis of the symptoms.  In terms of diagnostic tests, what I would say is we’re working closely with FDA on this.  And obviously with the state and local health department partners.  And I think that we are rapidly moving towards getting those kits more available in the U.S.  In the systems that we have.

Really I think we’re close.  I just wouldn’t want to give an estimate of when until we’re there.  But I think we’re close.  And remember, a dozen states now have the kit and are testing and there’s tests available in the U.S.  So I think we’re making forward progress.

Thank you.  And our next question comes from Lena Sun from Washington Post.  Your line is now open.

Thank you.  I had a couple questions.  One is if a dozen states have the kit, then do they still need to send those tests to CDC for confirmation?  Which are the states that have the tests?  And more broadly, your comments today seem to represent a significant escalation in the sort of severity and urgency of the now.  At a briefing this morning for Congress, I believe some members were told that we now face a very strong chance of an extremely serious outbreak.  Is that the CDC’s feeling right now that we face an extremely strong chance of a serious outbreak?

Okay.  So let’s see.  The first question, it’s 12 state or local health departments.  And so it’s not 12 states total.  We are still as a point of part of how we roll out these tests, those tests that are positive still do come to CDC for confirmation.  I think that’s just part of a normal process to ensure we are keeping to the utmost quality control.

I don’t have a list of state or local health departments in front of me, but I think we can provide that.  In terms of a change in tone, I guess what I would say is as I look back on the scripts of the telebriefings that we’ve given over the past month, we have for a long time been saying — we have for many weeks been saying that while we hope this is not going to be severe, we are planning as if it is.

The data over the last week and the spread in other countries has certainly raised our level of concern and raised our level of expectation that we are going to have community spread here.  So I think that that’s perhaps the change of tone you’ve seen.  I think what we still don’t know is what that will look like as many of you know.  We can have community spread in the united states and have it be reasonably mild.

We could have community spread in the united states and have it be very severe.  And so that is what — that is what we don’t completely know yet.  And we certainly also don’t exactly know when it’s going to happen.  I think it would be nice for everybody if we could say, you know, on this date is when it’s going to start.

We don’t know that yet.  And so that’s why we’re asking folks in every sector as well as people within their families to start planning for this because as we’ve seen from the recent countries that have had community spread when it is hit in those countries, it has moved quite rapidly.  So we want to make sure that the American public is prepared.

Thank you.  And as a reminder, if you would like to ask a question, please press star one.  Limit to one question and one follow-up.  Our next question comes from Eben from Fox news.  Your line is now open.

Thank you very much for doing the call today.  There has been some political back and forth now that democrats are accusing the president which essentially means the administration and everything that falls under that as being ill prepared for coronavirus, requesting too little of amount in terms of their request for $2.5 billion.  Do you feel that we are ill prepared from a financial standpoint?  I know you are a clinician and I don’t want you to get too much into politics, but do you have what you need to do your job?

I guess I’ll answer that two ways.  The first is HHS can provide information or answer questions about the funds that are available.  What I can say from my perspective is I’ve been at CDC for 25 years and that if you asked public health officials over the course of that time what they feared as an expectation, it was something exactly like this.

And so the idea that we might have a pandemic of influenza or a pandemic of a respiratory viral infection is something that we’ve known about and have been planning and preparing for.  That’s why we at CDC have been exercising with the state and local health departments.  That’s why the whole of government exercise last year, that’s why we’ve invested so much on the foundation we are now responding.  But that being said, we are never going to ever be able to be so completely prepared that we’re prepared for any inevitability.

We always are going to find that diseases surprise us and that there was some consideration that is slightly different from what we planned for.  So have we made a lot of progress in the 25 years I’ve been here?  Yes.  Are we better prepared today than we were 20 years ago?  Yes.  But are we completely prepared?  You know, diseases surprise us and therefore we need to be reacting to the current situation even if it differs from what we planned for.

You know, in general we are asking the American public to work with us to prepare in the expectation that this could be bad.  I continue to hope that in the end we’ll look back and feel like we are over-prepared, but that is a better place to be in than being under-prepared.

And just like the preparedness for a pandemic influenza provides such a strong foundation for this response, any preparedness we do as a country, at schools, businesses, within our families will always be helpful for whatever the next event is.  And so I don’t think in general that preparedness will ever go to waste.

Next question, please.

Thank you.  Our next question comes from Mike from A.P.  Your line is now open.

Hi.  Thank you for taking my call.  If I could ask a couple.  One is just the latest case count, it’s been a little confusing for some of us just to sort out exactly how many U.S.  Cases there are and how they’re being sorted out.  Second, if you could speak to your best and latest understanding of the severity of the disease.

Of course there’s some news today about the WHO mission coming back and statements about not finding a lot of undetected cases.  I was wondering if that’s related to CDC gearing up for these NPIs.  And lastly, talking about the exercising you’ve been doing, what was the weakness or weaknesses that kept coming up in the exercises that you’re most concerned about and you’re really trying to stay on top of now that we have a real time experience happening?  Thank you.

Okay.  So let me — so let me start by saying that I know the case counts can be confusing.  I will try to sort out what the numbers are as of today and try to explain why it perhaps is a little confusing.  There remain 14 confirmed U.S.  Cases.  We are separating out the cases among repatriated individuals.  So those are 14 U.S. Cases.  12 of those are travelers who returned from an area where disease is circulating.  Two of those are close contacts of another case.  That’s 14.

There are three novel coronavirus patients among people who are repatriated from Hubei that is in the repatriated flights.  And our website says 36 because we updated this yesterday, but in fact as of this morning, there are 40 positives among individuals repatriated from the “Diamond Princess.”  so these are Americans who were on board the “Diamond Princess”  repatriated back to the United States.  And that’s 40.

So that means just to go back that there are 14 confirmed cases picked up through the U.S. public health systems.  And 40 plus 3 makes 43 among individuals repatriated into the United States.  I do hope that helps.  In terms of the severity, I think that there are a variety of reports that give information about severity.  We’ve looked at severity among people, among reported people from Hubei.

We’ve looked at reported people from elsewhere in china.  And certainly the data coming out from Korea and Iran and Italy suggests also deaths which are concerning.  In terms of our messaging today, I really would say that it is more driven by the community spread in other countries than it is specifically from data from china.

And so I think it really is the spreading of COVID-19 through other countries that makes all of us feel that the risk of spread in the united states has — is increasing.  In terms of exercising, you know, there are always small and big things that we learn from exercising.  Maybe two specific things I’ll point out is that our exercising did show us that if we had a pandemic, there were going to be supply issues.

And I think that we are now across the whole of government thinking through and working on those supply issues.  One of them is enough protection for health care workers.  This is clearly a priority. The health care workers put themselves on the front line caring for ill patients and has to be a priority to make sure they are protected.  Another issue is the NPIs.  The non-pharmaceutical interventions.

We have worked across governmental sectors to get input into our planning guidance.  But it’s one thing to plan for those NPIs.  It’s certainly another thing to be able to implement them at a large scale.  And I think one of the reasons that we’re talking about this so proactively today is that we recognize that implementing NPIs at this level that we want to prepare the american people that their lives could be interrupted.  Next.

Thank you.  Our next question comes from Eric of ABC news.  Your line is open.

Thanks, Benjamin.  Thanks, Nancy for taking our questions.  I’m wondering like the chicken and the egg with the case definition and the testing.  If you’re telling us today it’s not a question of if but when there’ll be community spread and it’s very difficult to — for clinicians to know the difference between flu and COVID-19, how come you’re not widening the case definition to test more people?

So let me answer that two ways.  One is that we have more than one layer of surveillance.  I think I talked about this in a previous call, but maybe just to talk about it a little more.  There is a specific patient-under-investigation case definition that really does focus on travel because that is where the cases that are picked up through our public health systems are.  But we are also aware and concerned about the possibility for broader spread in the U.S.

That’s why the Secretary and we announced last week that we were going to be doing more community-based surveillance relying on the infrastructure of our influenza.  So we have already started that surveillance system.  We’re rapidly working within the next couple weeks to expand that more broadly.  As well, we have a variety of other more community-oriented surveillance systems that we’re working to stand up to be able to look for those cases in the community.  So this is proceeding in stages with the one surveillance but community surveillance also rapidly starting.

Brittany, we have time for two more questions, please.

Thank you.  And our next question comes from Lauren from San Antonio Express News.  Your line is now open.

Thank you for taking my call.  I wanted to ask about the 14-day incubation period that has been reiterated by many public health officials including the quarantine of the evacuees.  We’ve seen some isolated reports coming from other countries suggesting that it is possible that the incubation period has been longer in some individuals in other countries who have been quarantined for more than 14 days.  And I was wondering if you guys have any reason to suspect whether the incubation period may be longer than 14 days for those of Wuhan that have been released from their quarantine.

Thank you.  That’s actually a really important question.  And something we’re looking at closely.  Some of the reports that you’ve seen are reports in the media, not reports in peer reviewed literature.  And it impacts our ability to fully scientifically evaluate them.  As I’ve said in previous meetings, there are a team of — there are more than 50 modeling mathematical modeling groups in the United States all working with us to look at a variety of issues around this response to novel coronavirus.

One of the things they’re certainly analyzing is all of the available data on the incubation period.  And the data so far still supports using 14 days as the top window.  In terms of isolated reports elsewhere, there are a variety of possibilities.  One possibility is — there’s a variety of possibilities – what we’ll do is continue to synthesize and evaluate the available data trying to make a data-driven decision.  And if more data becomes available that suggests a longer incubation period, we will certainly be visible and public about that.  I think at this point, we’re still comfortable that 14 days is the appropriate top line for that.

Last question, please.

Thank you.  And our final question comes from Ben from CNN.  Your line is now open.

Hi, thanks so much for taking my question.  This morning while he was traveling in India, President Trump said that he thinks that the coronavirus is a problem that is going to go away.  He seems very optimistic about this and we’re trying to figure out exactly why he believes so strongly that to be the case.  And so my question for you is what information is your agency specifically giving the president and the White House about the current state of the coronavirus outbreak?

As you imagine, we brief the Secretary daily and the Secretary is the lead of the White House task force.  And Ddr. Redfield the CDC director is briefing them daily.  In terms of the course of this illness, we have a — again, a team of mathematical modelers working with us to try to predict the trajectory.  One hypothesis is that we could be hopeful that this could potentially be seasonal.

Other viral respiratory diseases are seasonal including influenza and therefore in many viral respiratory diseases, we do see a decrease in disease in spring and summer.  And so we could certainly be optimistic that this disease will follow suit. But we’re not going to know that until time keeps ticking forward.  We’re going to be, again, preparing as if this is going to continue, preparing as if we’re going to see community spread in the near term.

But I’m always going to be hopeful that that disease will decline either for the summer or that, you know, we’ll be over-prepared and we won’t see the high levels of transmission here in the U.S.

Thank you, doctor.  And thank you, all, for joining us for today’s briefing. Please visit CDC’s 2019 novel coronavirus website for continued updates.  And if you have further questions, please call the main media line at 404-639-3286 or email media@CDC.gov.  Thank you.

Thank you for your participation in today’s conference.  All participants may disconnect at this time.

How Do You Keep China’s Economy Running With 750 Million in Quarantine?

Not just China’s economy. How about all the nations that do so much import business from there?

BEIJING—Returning to China in mid-February, I had seemingly stepped into a parallel universe. Much of Beijing looked, and even smelled, like the familiar metropolis in which I’ve lived for decades. Except for one thing.

Where were all the people?

Meanwhile public trust in the system has been badly shaken, and coming weeks will determine whether the damage is irreparable or not. “Some days I don’t even make enough money to cover fuel costs and the daily 200 RMB [renminbi] I give to the taxi company,” complained Beijing taxi driver Yang Guoning. He said he’d asked the company for a daily subsidy but was told to “wait for the government policy.” What can he do in the meantime? “All I can do is show up for work and take all the precautions,” he said. What precautions? His voice dripped with sarcasm. “Wear a face mask. Disinfect my taxi. Roll down the windows, and get plenty of fresh air—after all, that’s what the government says I must do. What else is there?” He pressed the “down” button to further lower his taxi windows with an exaggerated gesture—and a look of disgust.

Most tragic are recurring reports—most often from Hubei but repeated in some other communities—of an overstressed public health system. Patient care has suffered from overtaxed medical staff, heartless forced quarantines, and shortages of beds, equipment, and diagnostic testing kits. Ailing Chinese were manhandled into strict isolation and then left untended. People suffering from unidentified or non-coronavirus complaints—from HIV/AIDS complications to cancer to injuries from exploding fireworks—were thrown out of hospitals to make way for high-priority novel coronavirus cases.

Such descriptions evoke wartime scenes from a combat triage tent—and that may be no accident. Girding to fight the “demon virus,” Xi himself has likened the anti-epidemic battle to a “people’s war.” The question is what happens if many people no longer believe him and begin to seek private survival strategies. For some, that might mean long delays before resuming work; if pervasive and prolonged, this could deal a body blow to China’s already slowing economy. Worse, others may try to evade their quarantines. The potential for even greater public health catastrophes is sobering.

The Chinese capital has more than 20 million residents. But the coronavirus that burst out of Hubei province—infecting some 79,000 worldwide and killing more than 2,600 (mostly in China)—had almost emptied Beijing’s vast boulevards. I felt as if I’d stumbled onto the set of a post-apocalyptic film. (Though the city confirmed only four coronavirus deaths, everyone was jittery about infection.) In my silent apartment building, 36 pages of warnings, notices, instructions, and lists of fever clinics were taped neatly to the lobby walls, with 11 more in the elevator. They told returnees to Beijing to scan a QR code (leading to a nosy questionnaire) and isolate themselves at home for 14 days.

I was asked some obvious questions: “Have you been to Hubei?” where the provincial capital, Wuhan, was the epicenter of the outbreak. (I haven’t been for years.) Plus less obvious questions, like my ethnic background and “Are you a member of the Communist Party?” I thought: Does being a member of the Chinese Communist Party have anything to do with whether one’s infected or not?

Actually, the party has something to do with everything in China, especially under Xi Jinping—and suddenly, for Xi, that has become a double-edged sword. As president, party head, and top military commander, Xi has consolidated his authority, centralized decision-making, abolished presidential term limits, and promoted his loyalists. People expect Xi, China’s “chairman of everything,” to fix everything when it goes wrong.

And this is an especially critical test for a Communist leader who has steadily gathered power since becoming party head in November 2012, turning himself into the most powerful Chinese leader since Mao Zedong, in the eyes of some observers. Now Xi and his party apparatus are scrambling to achieve two ambitions—both urgent but conflicting—at once. Xi must reduce (and hopefully eliminate) new coronavirus deaths and infections swiftly while simultaneously reviving China’s shellshocked economy. Problem is, people can’t get back to business if they’re hunkering in a bunker. Yet kick-starting economic activity is key if Beijing hopes to prevent this viral outbreak from becoming the “black swan” that Xi has always worried about, sabotaging China’s economy and the world’s along with it……..

 

South Korea virus cases jump again, 1st US soldier infected

The U.S. military says one of its soldiers based in South Korea tested positive for a new virus, the first U.S. service member infected.

A U.S. military statement said the 23-year-old man is in self quarantine at his off-base residence. It says the soldier was originally based in Camp Caroll in a town near the southeastern city of Daegu, where most of South Korea’s virus cases are clustered.

South Korea has almost 1,150 cases of the new coronavirus, the biggest outbreak outside mainland China. About 28,500 U.S. troops are stationed in South Korea as deterrence against potential aggression from North Korea.

U.S. health officials urge Americans to prepare for spread of coronavirus

WASHINGTON/CHICAGO (Reuters) – The U.S. Centers for Disease Control and Prevention (CDC) on Tuesday alerted Americans to begin preparing for the spread of coronavirus in the United States after infections surfaced in several more countries.

The announcement signaled a change in tone for the Atlanta-based U.S. health agency, which had largely been focused on efforts to stop the virus from entering the country and quarantining individuals traveling from China.

“The data over the past week about the spread in other countries has raised our level of concern and expectation that we are going to have community spread here,” Dr. Nancy Messonnier, the CDC’s head of respiratory diseases, told reporters on a conference call.

What is not known, she said, is when it will arrive and how severe a U.S. outbreak might be. “Disruption to everyday life might be severe” and businesses, schools and families should begin having discussions about the possible impact from the spread of the virus, Messonnier cautioned.

In a teleconference later on Tuesday, Dr. Anne Schuchat, the CDC’s principal deputy director, said that while the immediate risk in the United States was low, the current global situation suggested a pandemic was likely.

“It’s not a question of if. It’s a question of when and how many people will be infected,” Schuchat said.

Separately, U.S. Health and Human Services (HHS) Secretary Alex Azar told a Senate subcommittee there will likely be more cases in the United States, and he asked lawmakers to approve $2.5 billion in funding to fight the outbreak after proposing cuts to the department’s budget.

Italy reports 6 dead, 229 infected as Europe braces for COVID-19

…. Italian health officials reported Monday that there are 229 people infected nationwide, with six deaths.

There are 101 people in the hospital, and 27 are in intensive care.

The hard-hit northern region of Lombardy reported 172 cases. Five of the deaths are in the Lombardy region……

At least 10 towns in northern Italy, with a population of around 50,000, were locked down Sunday to help stop the spread of the virus.

Iran Denies Cover-Up After Lawmaker Contradicts Official Coronavirus Figures, Says 50 Dead

Take you pick of the numbers from the another country whose rulers are known for lying through their teeth

A member of Iran’s parliament announced on Monday that 50 people had died from the new coronavirus in the city of Qom and accused Iran’s Health Ministry of covering up the true extent of the outbreak in the country. The Health Ministry claims just 12 people have died in Iran from COVID-19, with 66 people sick from the disease. The official numbers in Iran were up from a total of 8 deaths and 43 illnesses reported on Sunday.

Ahmad Amirabadi Farhani, who represents Qom, a city roughly 120 kilometres south of Tehran, told Iran’s semiofficial news outlet ILNA that he believes the death count in his city was far higher than what the Iranian government was saying.

“Up until last night, around 50 people died from coronavirus. The health minister is to blame,” Amirabadi Farhani said on Monday, according to an English translation by Middle East news network Al Arabiya, adding that he believes 10 people are dying per day.

S.Korea reports 161 new cases of coronavirus, brings total to 763

SEOUL, Feb 24 (Reuters) – South Korea reported 161 new cases of the coronavirus, bringing the total number of infected patients in the country to 763, health authorities said on Monday, a day after the government raised its infectious disease alert to its highest level.
Of the new cases, 115 were linked to a church in the southeastern city of Daegu after a 61-year-old woman known as “Patient 31” who attended services there tested positive, according to the Centres for Disease Control and Prevention (KCDC).

KCDC also reported the seventh death from the virus, a 62-year-old man from a hospital in Cheongdo, a county that saw surges in confirmed cases along with nearby Daegu in recent weeks.

Authorities are still investigating the exact cause of the new outbreak, with Patient 31 having no recent record of overseas travel.

Josh Hawley: Legislation ‘Necessary’ to Address Chinese Monopoly of U.S. Drug, Medical Supplies

Sen. Josh Hawley (R-MO) wrote a letter to the U.S. Food and Drug Administration (FDA) Monday, contending that it is “inexcusable” that America relies on China for its medical supply chain. Hawley called hearings and legislation to determine how to address America’s reliance on Chinese for producing vital medicine.

The Missouri conservative wrote a letter to U.S. FDA Commissioner Stephen Hahn after reports revealed that the coronavirus has jeopardized the “domestic supply of some 150 prescription drugs, including antibiotics, generics, and branded drugs.”

Hawley said that the time is coming for Congress to have oversight and consider legislation to address the insecurity of America’s medical supply chain.

Hawley wrote to Hahn:

The degree to which some of our own manufacturers rely on China to produce life-saving and life-sustaining medications is inexcusable. It is becoming clear to me that both oversight hearings and additional legislation are necessary to determine the extent of our reliance on Chinese production and protect our medical product supply chain.

Reports have revealed the extent to which China produces and exports the overwhelming majority of pharmaceuticals to the United States. China exports 97 percent of all antibiotics and 80 percent of active ingredients used to make drugs in Americans.

Another report stated that America is losing its ability to make pharmaceuticals because of Chinese dumping of low-price products into the global market.

Coronavirus disease 2019 (COVID-19)
Situation Report – 34

• No new countries reported cases of COVID-19 in the past 24 hours.

SITUATION IN NUMBERS
total and new cases in last 24 hours
Globally
78 811 confirmed (1017 new)
China
77 042 confirmed (650 new)
2445 deaths (97 new)
Outside of China
1769 confirmed (367 new)
28 countries
17 deaths (6 new)

Pandemic Seems Likely as Coronavirus Outbreaks Worsen in Several Countries.

On Friday, the head of the World Health Organization offered a stark warning about the chances of containing the global spread of the novel coronavirus amid ominous new outbreaks of the disease outside of China. “The window of opportunity is still there, but our window of opportunity is narrowing,” explained WHO director-general Tedros Adhanom Ghebreyesus. By Sunday, it seemed clear that window may have already closed.

Authorities are now struggling to contain — and understand — escalating outbreaks in three countries, South Korea, Iran, and Italy, while additional countries, like Lebanon and Israel, have recently reported their first cases as well.

 

Two Dead, 79 Infected as Italy’s Government Fights Coronavirus Outbreak

Cases of the new coronavirus in Italy, the most affected country in Europe, rose on Saturday to nearly 80, killing two people and prompting the government to close off the worst hit areas in the northern regions of Lombardy and Veneto.

Authorities in the two regions, where the outbreak is concentrated, have cancelled sports events and closed schools and universities, while companies from Ray-Ban owner Luxottica to the country’s top bank UniCredit have told workers living in the affected areas to stay home.

Iran Now Says 6th Person Dead of New Virus

TEHRAN, Iran — Iranian officials Saturday reported a sixth death from the new virus that emerged in China.

The governor of Markazi province told the official IRNA news agency that tests of a patient who recently died in the central city of Arak were positive for the virus.

Ali Aghazadeh said the person was also suffering from a heart problem.

Earlier on Saturday, health authorities reported a fifth death from the coronavirus and said the fatality was among 10 new confirmed cases in Iran. It was not immediately clear whether the sixth fatality was among those 10.

Coronavirus Cases Triple in South Korea; Who Keeps Eye on Africa, Iran

The number of new coronavirus cases nearly tripled in South Korea on Saturday, the fourth consecutive day that tally has seen a major spike. Korea Centers for Disease Control and Prevention reported that the total number of confirmed cases in the country rose to 433 — less than 24 hours after the sum stood at 156.

As of Tuesday, the number of confirmed cases was just 31.

Many of the new patients Saturday were located in or near Daegu, South Korea’s fourth-largest city, where dozens of people linked with a Christian sect known as the Shincheonji Church of Jesus have shown symptoms of respiratory illness. The church, which has about 150,000 adherents, says it has shared with authorities the names of members who may have been exposed to the virus, and it is encouraging them to enter quarantine.

 

Judge temporarily halts transfer of coronavirus patients to quarantine facility in California city.

A city in California won a battle against the state Friday, at least temporarily, when a judge halted the transfer of people diagnosed with the coronavirus to its community for a quarantine site.

Costa Mesa, California, filed a legal action after it learned federal officials planned to use its Fairview Development Center to house and quarantine several patients who tested positive for the COVID-19 virus.

The city said it was given little notice, and without input, about the plan.

“We have received no information regarding how the facility will be prepared, what precautions will be taken to protect those in the facility as well as those who live nearby, and other important planning measures,” Costa Mesa Mayor Katrina Foley said in a statement.

Judge Josephine Staton, according to the city, issued the temporary restraining order late Friday night. An expedited hearing is expected to be held Monday afternoon.

One key indicator will tell us when the coronavirus outbreak is winding down — but we’re not seeing it yet.

It has been more than seven weeks since the coronavirus outbreak started in Wuhan, China. Since then, at least 2,250 people have died and more than 76,000 have gotten sick.

The virus’ continued spread prompts an obvious question: When will this end?

A recent study from the Chinese Center for Disease Control found that illnesses in China may have peaked on February 1, when the largest number of patients started showing symptoms. That could be a sign that the outbreak is already tapering off, but the researchers also warned that it could rebound once Chinese residents return to school and work.

“The data from China continue to show a decline in new confirmed cases,” Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said at a press conference on Thursday. “We’re encouraged by this trend, but this is no time for complacency.”

Lauren Ancel Meyers, an epidemiologist at the University of Texas at Austin, told Business Insider that one important figure can tell us when the outbreak has run its course. It’s the average number of people that a single patient is expected to infect. Epidemiologists call it the “basic reproduction number,” and it indicates how contagious a virus is.

When the outbreak is winding down, Meyers said, the basic reproduction will be below one.

“That means, on average, every person is infecting fewer than one other person and then the outbreak should burn out,” she said.

That’s not the case yet. A recent study of nearly 140 hospitalized patients in Wuhan estimated that the basic reproduction number for the coronavirus is 2.2, meaning that patients have been spreading the virus to more than two other people, on average. A study in the Journal of Travel Medicine estimated that the reproduction number was slightly higher: around 3.3.

Wuhan Woman With No Symptoms Infects Five Relatives With Coronavirus: Study

Maybe like this?
A person can have it, show no symptoms, but still spread it?

(Reuters) — A 20-year-old Chinese woman from Wuhan, the epicenter of the coronavirus outbreak, traveled 400 miles(675 km) north to Anyang where she infected five relatives, without ever showing signs of infection, Chinese scientists reported on Friday, offering new evidence that the virus can be spread asymptomatically.

The case study, published in the Journal of the American Medical Association, offered clues about how the coronavirus is spreading, and suggested why it may be difficult to stop.

“Scientists have been asking if you can have this infection and not be ill? The answer is apparently, yes,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center, who was not involved in the study.

China has reported a total of 75,567 cases of the virus known as COVID-19 to the World Health Organization (WHO) including 2,239 deaths, and the virus has already spread to 26 countries and territories outside of mainland China.

U.S. Prepares for Coronavirus Pandemic, School and Business Closures: Health Officials

So the CDC is advising ‘preparation’? Like they’re expecting something?

(Reuters) — U.S. health officials on Friday said they are preparing for the possibility of the spread of the new coronavirus through U.S. communities that would force closures of schools and businesses.

The United States has yet to see community spread of the virus that emerged in central China in late December. But health authorities are preparing medical personnel for the risk, Nancy Messonnier, an official with the Centers for Disease Control and Prevention (CDC) told reporters on a conference call.

In coming weeks, if the virus begins to spread through U.S. communities, health authorities want to be ready to adopt school and business closures like those undertaken in Asian countries to contain the disease, Messonnier said.

“We’re not seeing community spread here in the United States yet, but it’s very possible, even likely, that it may eventually happen,” Messonnier said.

“Our goal continues to be to slow the introduction of the virus into the U.S. This buys us more time to prepare communities for more cases and possibly sustained spread.”

What? The published CDC numbers haven’t changed.
Looks like the city of Costa Mesa didn’t get the note to shut up, or something.
So, are there any more that we haven’t been told about?
We knew we couldn’t trust the figures coming from the Chinese goobermint.
Why we should trust ours any further is one to ponder.

Costa Mesa Seeks To Block Transfer Of Up To 70 Coronavirus Patients To City

COSTA MESA (CBSLA) – Costa Mesa is trying to block as many as 70 confirmed coronavirus patients from being transferred to the city.

Federal court papers filed Friday state that the federal government plans to transfer the patients from Travis Air Force Base near Sacramento to the former Fairview Development Center on Sunday. Last night officials began hearing of the plan by the Department of Health and Human Services and the CDC to move between 30 and 76 patients to the state-owned land.

Some of the patients are from the Diamond Princess cruise ship from which more than 300 U.S. citizens were removed Monday.

City leaders say that they filed an injunction to stop the transfer in an effort to protect Costa Mesa residents.

“We have a lot of activity in the area.” said Mayor Katrina Foley. “So, it’s not the kind of area that’s isolated and that would be appropriate for quarantining people who have an infectious disease,” said Mayor Katrina Foley.

The largest concern is the lack of information, despite the fact that the patients are expected to arrive in a matter of days, said Costa Mesa fire chief Dan Stefano.

“There has not been an information flow, and in a situation like that, for us, it creates the greatest concern,” he said.

While it is known that the patients are California residents and some may be coming from the Diamond Princess cruise ship, city manager Loriann Farrell Harrison said the city needs to know more before feeling comfortable with the transfer.

“The reason that we have followed through with an injunction is because we don’t have a lot of information. We would like to know more about who the individuals are,” she said.

According to the injunction, the city of Costa Mesa seeks to stop the transfer until “an adequate site survey has been conducted, the designated site has been determined suitable for this purpose, all necessary safeguards and precautions have been put in place, and the public and local government have been informed of all efforts to mitigate risk of transmission of the disease.”

Coronavirus up to 20 times more likely than Sars to bind to human cells, study suggests

That means ‘more contagious’.

  • New strain appears to be more readily transmitted from human to human than Sars, Texas researchers find
  • Further studies needed to explore human host cells’ role in spread between people, the report says

The deadly new coronavirus is up to 20 times more likely to bind to human cell receptors and cause infection than severe acute respiratory syndrome (Sars), a new study by researchers at the University of Texas at Austin has found.

The novel coronavirus and Sars share the same functional host-cell receptor, called angiotensin-converting enzyme 2 (ACE2).

The report, published on the website bioRxiv on Saturday, said the new coronavirus had around 10 to 20-fold higher affinity – the degree to which a substance tends to combine with another – for human ACE2 compared with Sars.

But the researchers added that further studies were needed to explore the human host-cell receptor’s role in helping the new virus to spread from person to person.

“Compared with SARS-CoV, 2019-nCoV appears to be more readily transmitted from human to human,” the report of the study said. “The high affinity of 2019-nCoV S for human ACE2 may contribute to the apparent ease with which 2019-nCoV can spread from human to human.”

The disease caused by the new coronavirus, which the World Health Organisation (WHO) has named Covid-19, has killed more than 1,800 people and infected over 70,000 worldwide.

The number of Covid-19 deaths is more than double the global figure of 813 attributed by the WHO to the Sars epidemic of 2002-03.

The new study found that although the novel coronavirus’ receptor-binding domain (RBD) had a relatively similar structure to that of Sars, it did not have appreciable binding to three published Sars RBD-specific monoclonal antibodies (mAbs), which are copies of one type of antibody used to neutralise pathogens.

The researchers said this suggested antibody cross-reactivity – the extent to which different antigens appear similar to the immune system – may be limited between the two virus RBDs, meaning Sars-directed mAbs will not necessarily work against the new virus.

Instead, they identified the spike protein of coronaviruses, which is essential to gain entry into host cells during the infection process, as the most important target for vaccines, therapeutic antibodies and diagnostics.

“Due to the indispensable function of the [spike] protein it represents a vulnerable target for antibody-mediated neutralisation,” the report said. “Knowing the atomic-level structure of the spike will support precision vaccine design and discovery of antivirals, facilitating medical countermeasure development.”

The WHO has declared the outbreak a global public health emergency, making it the sixth incident to date to warrant that designation.

There are currently no specific treatments for the novel coronavirus but the WHO director general Tedros Adhanom Ghebreyesus said last week that the first vaccine may be available in 18 months.